|
HC CULTURE, FUNGI, DEFINITIVE ID, YEAST
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
3068710601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC CULTURE, FUNGI, DEFINITIVE ID, YEAST
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
3068710601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Government |
$10.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.22
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.77
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.32
|
| Rate for Payer: EmblemHealth Commercial |
$10.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.18
|
| Rate for Payer: Group Health Inc Commercial |
$10.32
|
| Rate for Payer: Group Health Inc Medicare |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Healthfirst Essential Plan |
$22.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.32
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: Humana Medicare |
$10.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$13.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
|
|
HC CULTURE, FUNGI, MOLD/YEAST, PRESUMPTIVE ID, BLOOD
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
3068710301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.50
|
|
|
HC CULTURE, FUNGI, MOLD/YEAST, PRESUMPTIVE ID, BLOOD
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
3068710301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.46
|
| Rate for Payer: Aetna Government |
$20.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.32
|
| Rate for Payer: Brighton Health Commercial |
$38.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.46
|
| Rate for Payer: EmblemHealth Commercial |
$20.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.21
|
| Rate for Payer: Group Health Inc Commercial |
$20.46
|
| Rate for Payer: Group Health Inc Medicare |
$20.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.48
|
| Rate for Payer: Healthfirst Essential Plan |
$25.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.46
|
| Rate for Payer: Healthfirst QHP |
$20.46
|
| Rate for Payer: Humana Medicare |
$20.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.46
|
| Rate for Payer: United Healthcare Commercial |
$11.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.48
|
| Rate for Payer: Wellcare Medicare |
$18.41
|
|
|
HC CULTURE, FUNGI, MOLD/YEAST, PRESUMPTIVE ID, OTHER THAN BLOOD
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
3068710201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.41
|
| Rate for Payer: Aetna Government |
$8.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.89
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.41
|
| Rate for Payer: EmblemHealth Commercial |
$8.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.48
|
| Rate for Payer: Group Health Inc Commercial |
$8.41
|
| Rate for Payer: Group Health Inc Medicare |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.41
|
| Rate for Payer: Healthfirst Essential Plan |
$18.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.41
|
| Rate for Payer: Healthfirst QHP |
$8.41
|
| Rate for Payer: Humana Medicare |
$8.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare Commercial |
$10.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.41
|
| Rate for Payer: Wellcare Medicare |
$7.57
|
|
|
HC CULTURE, FUNGI, MOLD/YEAST, PRESUMPTIVE ID, OTHER THAN BLOOD
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
3068710201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
3068710101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
|
|
HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
3068710101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$17.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.71
|
| Rate for Payer: Aetna Government |
$7.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.40
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.71
|
| Rate for Payer: EmblemHealth Commercial |
$7.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.86
|
| Rate for Payer: Group Health Inc Commercial |
$7.71
|
| Rate for Payer: Group Health Inc Medicare |
$7.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.71
|
| Rate for Payer: Healthfirst Essential Plan |
$17.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.71
|
| Rate for Payer: Healthfirst QHP |
$7.71
|
| Rate for Payer: Humana Medicare |
$7.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.71
|
| Rate for Payer: United Healthcare Commercial |
$9.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.71
|
| Rate for Payer: Wellcare Medicare |
$6.94
|
|
|
HC CULTURE, GC
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707008
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, GC
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707008
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, LEGIONELLA SPECIES
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, LEGIONELLA SPECIES
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707011
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, NASAL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, NASAL
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707007
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, OTHR SPECIMN AEROBIC
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, OTHR SPECIMN AEROBIC
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, RESPIRATORY
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, RESPIRATORY
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707003
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, ROUTINE AEROBIC
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707004
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, ROUTINE AEROBIC
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707004
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, SPORE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, SPORE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, THROAT SCREEN
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC CULTURE, THROAT SCREEN
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
3068707002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.62
|
| Rate for Payer: Aetna Government |
$8.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.03
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.62
|
| Rate for Payer: EmblemHealth Commercial |
$8.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.67
|
| Rate for Payer: Group Health Inc Commercial |
$8.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Healthfirst Essential Plan |
$18.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.62
|
| Rate for Payer: Healthfirst QHP |
$8.62
|
| Rate for Payer: Humana Medicare |
$8.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare Commercial |
$10.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.23
|
| Rate for Payer: Wellcare Medicare |
$7.76
|
|
|
HC CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB, MYCOBACTERIA) ANY SOURCE, WITH ISOLATION
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 87116
|
| Hospital Charge Code |
3068711601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.50 |
| Max. Negotiated Rate |
$39.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.50
|
|
